Sonobe Makoto, Yamada Tetsu, Sato Masaaki, Menju Toshi, Aoyama Akihiro, Sato Toshihiko, Chen Fengshi, Omasa Mitsugu, Bando Toru, Date Hiroshi
Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan,
Ann Surg Oncol. 2014 Aug;21(8):2546-54. doi: 10.1245/s10434-014-3630-9. Epub 2014 Mar 17.
This retrospective study aimed to determine prognostic factors associated with postrecurrence survival of completely resected non-small cell cancer patients with postoperative recurrence.
Characteristics, treatment modality, and postrecurrence survival of 234 patients (157 males and 77 females, mean age at recurrence: 68.7 years, 152 adenocarcinomas and 82 non-adenocarcinomas), who underwent complete resection for non-small cell lung cancer between 2003 and 2009 at our hospital and experienced recurrence, were analyzed for prognostic factors. Cox proportional hazard model was applied for multivariate analysis.
Among 234 patients, the median survival time after the diagnosis of recurrence was 21 months, and the 5-year postrecurrence survival rate was 19.9 %. Eastern Cooperative Oncology Group Performance Status (ECOG PS) (hazard ratio [HR]: ECOG PS-0/PS-1/PS-2 = 1/3.313/7.622), time to recurrence after surgery (HR: >2 years/1-2 years/<1 year = 1/1.881/2.185), and number of initial recurrent organs (HR: 1 organ/2 organs/3 or more organs = 1/1.896/2.818) were independent prognostic factors. Patients who received resection or stereotactic irradiation for limited number of brain metastases or solitary extracranial metastasis, and those who received mediastinal radiation or chemoradiation for recurrence at regional lymph nodes and/or resected stump had better survival (median survival time after recurrence: 34, 64, and 25 months, respectively).
Poor ECOG PS, shorter time from initial surgery to recurrence, and increasing number of initial recurrent regions are associated with poor prognosis after recurrence. When the number of recurrent lesions is limited, intensive local treatment with curative intent should be applied for achieving long-term postrecurrence survival.
本回顾性研究旨在确定完全切除的非小细胞癌术后复发患者复发后生存的预后因素。
分析了2003年至2009年在我院接受非小细胞肺癌完全切除且出现复发的234例患者（157例男性和77例女性，复发时平均年龄：68.7岁，152例腺癌和82例非腺癌）的特征、治疗方式及复发后生存情况，以寻找预后因素。采用Cox比例风险模型进行多因素分析。
234例患者中，复发诊断后的中位生存时间为21个月，复发后5年生存率为19.9%。东部肿瘤协作组体能状态（ECOG PS）（风险比[HR]：ECOG PS-0/PS-1/PS-2 = 1/3.313/7.622）、术后至复发的时间（HR：>2年/1 - 2年/<1年 = 1/1.881/2.185）以及初始复发器官数量（HR：1个器官/2个器官/3个或更多器官 = 1/1.896/2.818）是独立的预后因素。对于有限数量脑转移或孤立颅外转移接受切除或立体定向放疗的患者，以及对于区域淋巴结和/或切除残端复发接受纵隔放疗或放化疗的患者，生存情况较好（复发后的中位生存时间分别为34、64和25个月）。
ECOG PS差、初次手术至复发时间短以及初始复发区域数量增加与复发后预后不良相关。当复发病变数量有限时，应采用有治愈意图的强化局部治疗以实现复发后的长期生存。
